#267 Hospitalization Outcomes Associated with Minimally Invasive Surgery with Sextant vs Open Posterior/Transforaminal Lumbar Interbody Fusion: A Retrospective Study
General Session: Advocacy of MIS
Presented by: J. Kemner
J.E. Kemner (1)
Z. Ihara (1)
M.J. Lage (2)
(1) Medtronic, Memphis, TN, USA
(2) HealthMetrics Outcomes Research, Delray Beach, FL, USA
Introduction: This study compared hospitalization length of stay, rates of infection, and re-hospitalization rates between patients who underwent an inpatient posterior/transforaminal lumbar interbody fusion (P/TLIF) via open surgery and patients who had minimally invasive surgery (MIS) with Medtronic CD Horizon® SextantTM spinal system (Sextant).
Methods: The Premiere Perspective Database was used to retrospectively identify patients who underwent an inpatient open or minimally invasive (Sextant) P/TLIF over the time period from January 1, 2006 through December 31, 2010. Multivariate analyses were used to examine hospital length of stay, the probability of perioperative infection, and the probability of being re-hospitalized for back-related reasons. Specifically, a negative binomial regression was used to examine hospital length of stay while logistic regressions were used to examine the probability of infection or re-hospitalization. The analyses controlled for patient characteristics, patient general health, hospital characteristics and procedure level.
Results: There were 37,731 individuals included in the analyses: 36,372 who underwent an open P/TLIF and 1,359 with a MIS with Sextant P/TLIF. Descriptive statistics revealed that patients who underwent a MIS with Sextant had significantly shorter index hospitalization stays (3.68 days v 3.24 days; P< 0.0001), lower rates of infection while hospitalized (8.54% v 14.43%; P< 0.0001) and were less likely to have a back-related re-hospitalization (12.21% v 15.56%; P=0.0008), compared to patients who underwent an open/TLIF surgery. Multivariate analyses were consistent with the results of the descriptive statistics. Specifically, there was a significantly shorter hospital length of stay (-0.16 days; P< 0.0001) and a significant reduction in the odds of infection (Odds Ratio [OR] = 0.590; 95% Confidence Interval [CI] 0.484-0.718) associated with MIS with Sextant, compared to open surgery. Furthermore, patients who underwent an MIS with Sextant were 16% less likely to be re-hospitalized with an accompanying diagnosis of back pain (OR=0.841; 95% CI 0.711 - 0.996) compared to those who had open surgery. Results also indicated that age and comorbidity at baseline were independently associated with worse outcomes while Commercial Insurance, treatment at a teaching hospital, or residence in the Midwest or Northeast were associated with improved outcomes.
Conclusions: In this study, MIS with Sextant compared to open surgery for P/TLIF was associated with significantly shorter hospital length of stay, lower infection rates and a reduced probability of back-related re-hospitalization. These results suggest that MIS with Sextant may improve patient outcomes by reducing complications while utilizing fewer hospital resources.